Biggest risk to NHS is doing nothing, says David Cameron

PM defends overhaul of NHS ahead of second debate on health and social care bill as protesters opposed to the reforms plan to demonstrate outside parliament

The prime minister waded into the row over controversial NHS reforms this morning with a stark warning that the health service will become "increasingly unaffordable" unless government plans are implemented.

David Cameron took to the airwaves to argue that the "biggest risk" to the NHS would be to "do nothing". The government's health and social care bill, which MPs debate today, would hand GPs �80bn of the NHS budget to commission patient care and see NHS hospitals compete with charities and private companies to provide services.

He said the demand for NHS services was outpacing the cash available. "If you look at the growth of the elderly population, look at the new drugs that are coming on stream, the new treatments, if we keep the system we have now and don't make changes to cut bureaucracy and waste, I think it will become increasingly unaffordable," he told BBC Breakfast. "The risk is doing nothing."

Cameron's remarks came as protesters opposed to the reforms planned to demonstrate outside parliament as ministers begin a second debate on the controversial bill.

A YouGov poll, commissioned by Unison, the UK's largest public sector union, showed that only 27% support GPs using private companies to provide NHS services and 50% oppose the measure, In an article for the Times (paywall), Cameron took ownership of the reforms, which are being taken through parliament by the health secretary, Andrew Lansley, saying the blueprint for the NHS was an "evolution not revolution" and built on the work of previous administrations.

He dismissed the argument offered by critics that the sick would suffer, saying the "freedom of GPs to choose whatever is best for their patients" represented "progress", not "privatisation".

He also claimed that Britain's "health outcomes lag behind the best in Europe. Without modernisation, the principle we all hold dear ? that the NHS is free to all who need it, when they need it ? will become unaffordable".

However, last week John Appleby, chief economist at the King's Fund thinktank, cast doubt over this argument, saying that the NHS compares more favourably to the rest of Europe than ministers claim.

In the British Medical Journal, Appleby said deaths from heart attacks and cancer were actually falling, despite lower spending on health than other European countries.

The economist also challenged a ministerial briefing for the government's health bill which claimed that the number of deaths in Britain from heart disease was double that in France. Britain, he said, had seen the largest fall in death rates from heart attacks of any European country between 1980 and 2006.

"Comparing just one year ? and with a country with the lowest death rate for myocardial infarction in Europe ? reveals only part of the story," he said. If trends from the past 30 years continue, the UK will have a lower death rate from heart attacks than France as soon as 2012.

Other experts worry that the government is going "too fast". They point out that at the same time as implementing the reforms, which envisage a cull of 24,000 managers, NHS leaders need to deliver �20bn of efficiency savings to bridge the gap between rapidly increasing demand and limited rises in the health budget.

One of the most radical cost-saving measures in the package of reforms is that hospitals will be allowed to undercut each other on the price they charge for treating NHS patients. The Royal College of Surgeons says this may compromise standards of patient care if doctors focus on low prices rather than quality.

But even those who are not against the principle of competition said the quality of care could suffer. "There are risks to quality associated with price competition, where quality cannot be measured in a way that is clear and easily comparable," said a briefing paper by the NHS Confederation, which represents 95% of the health service.

Nigel Edwards, chief executive of the independent membership body, said the debate over the use of markets in healthcare had been "unhelpfully polarised" and warned the issues had been "poorly understood".

He added that opportunities to improve care could be missed without a proper debate. "The idea of harnessing the power of markets and competition to create change has underpinned much of recent healthcare reform in the UK and other countries. But in this country the debate is unhelpfully polarised, characterised more by assertion and dogma than by evidence."

Randeep Ramesh

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